Cough and you'll miss itCough and you'll miss it

Foreign body aspiration is a potentially fatal occurrence, particularly in children less than 3 years of age. Predisposing factors include the tendency to put objects into the mouth, poor chewing ability, lack of posterior dentition and uninhibited inspirations when laughing or crying. Classically, the history opens with a witnessed choking episode which would raise a high level of suspicion in the clinician. Ideally, this would lead to an investigative cascade resultant in prompt diagnosis and removal of the object without significant sequelae. The clinical presentation, however, of an unwitnessed foreign body aspiration can be non-specific and subtle from acute shortness of breath and difficulty breathing to intractable cough, fever and chronic wheeze. It can masquerade as a reactive airway or primary infective pathology and delay crucial diagnosis. A high index of suspicion is therefore required when assessing a child with any of these complaints. Commonly aspirated substances include food particles, hardware and toys. Retained foreign bodies can lead to severe and dangerous long-term consequences including atelectasis, pneumothorax, pneumomediastinum or even death. The purpose of this case is to demonstrate the diagnostic dilemma when dealing with young children and the understated presentation of an unwitnessed aspiration of a foreign body.